The difference between eating disorders and disordered eating, and why it matters to you

The other day I walked past a table in the dining hall and heard a girl say, “I used to purge once in a while but I was never bulimic.”

One time a male friend said to me “what you feel sounds serious but at least it isn’t a real eating disorder.”

I once sat incredulously next to one of my girlfriends as she said to another “you haven’t eaten today at all, you’re like totally anorexic.”

For so many reasons, it’s important that we be very clear about what the difference is between an eating disorder and disordered eating.

In this post today I’ll demonstrate the difference, and then talk about why it’s so important, and what we should do with it in our own lives.

What is an eating disorder?

An eating disorder is a psychological disorder officially classified in the one document regarded as the world authority on mental disorders, the DSM. The DSM is re-issued periodically. The most recent issue was number V, and it came out just last year.

There are four diagnoses of eating disorders in the DSM: anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorder not otherwise specificed. Each of these disorders has specific criteria:

Anorexia:

Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.

Intense fear of gaining weight or becoming fat, even though underweight.

Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

Bulimia:

Recurrent episodes of binge eating characterized by BOTH of the following:

Eating in a discrete amount of time (within a 2 hour period)large amounts of food.

The binge eating and compensatory behaviors both occur, on average, at least once a week for three months.

Self-evaluation is unduly influenced by body shape and weight.

The disturbance does not occur exclusively during episodes of anorexia nervosa.

Binge Eating Disorder:

Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

eating, in a discrete period of time (for example, within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances

a sense of lack of control over eating during the episode (for example, a feeling that one cannot stop eating or control what or how much one is eating)

The binge-eating episodes are associated with three (or more) of the following:

eating much more rapidly than normal

eating until feeling uncomfortably full

eating large amounts of food when not feeling physically hungry

eating alone because of feeling embarrassed by how much one is eating

feeling disgusted with oneself, depressed, or very guilty afterwards

Marked distress regarding binge eating is present.

The binge eating occurs, on average, at least once a week for three months.

The binge eating is not associated with the recurrent use of inappropriate compensatory behavior (for example, purging) and does not occur exclusively during the course Anorexia Nervosa, Bulimia Nervosa, or Avoidant/Restrictive Food Intake Disorder.

All of which is to say that eating disorders are quite specific, and identifying someone’s behavior as such has important implications for the type of treatment they receive, the recommendations their doctors make, and the way in which their health insurance companies handle them.

What is disordered eating then?

Disordered eating is pretty much all neurotic or mentally unhealthy ways of interacting with food that do not fall under these set criteria.

Whereas 0.5% of American women suffer from anorexia and 2.5% of women from bulimia (and both of which having higher rates in college, statistics from here), it is estimated that more than 50% of Americans suffer from some sort of negative or disordered behavior around food. People who have clinical eating disorders are a small subset of a very large group of people who struggle with food.

Symptoms of disordered eating may include behavior commonly associated with eating disorders, such as food restriction, binge eating, purging (via self induced vomiting or excessive exercise, and use of diet pills and/ or laxatives). Disordered eating may also be indicated by:

Yo yo dieting

Obsession with diets

Self worth or self esteem based highly or even exclusively on body shape and weight

A disturbance in the way one experiences their body i.e. a person who falls in a healthy weight range, but continues to feel that they are overweight

Excessive or rigid exercise routine

Obsessive calorie counting

Orthorexic behaviors, an obsesion with ‘clean’ eating

Rigid adherence to a particular dietary paradigm

Anxiety about certain foods or food groups

A rigid approach to eating, such as only eating certain foods, inflexible meal times, refusal to eat in restaurants or outside of one’s own home

The difference between eating disorders and disordered eating is one of degree

The motivations that someone may have for developing an eating disorder are highly complex. We could talk about body image and food issues all day long, and that very well often plays a role in eating disorders. Yet more complex and varied psychological issues often play a role: significant trauma, childhood trauma, dysfunctional behaviors in the family, feelings of helplessness and lack of control, social anxiety, sexual and emotional abuse and many other problems often come into play. It is also often hypothesized that genetics may play a role in the development of eating disorders, making some people more susceptible to developing them than others.

These motivations result in behaviors that are demonstrably physically harmful to the person enacting them. Significant nutrient depletion and caloric deprivation are problems for anorexia, which very often lead to death in the end. For bulimia, metabolic derangement may result, and also many gastrointestinal disorders, stomach acid issues, and the decay of tooth enable. Binge eating disorder may also have significant physiological effects as bingeing cycles can also seriously harm the gut and the body’s metabolism.

In some sense, you could say that these severe psychological issues and severe physical problems are what distinguish eating disorders from disordered eating. Yet when we take a good, hard look at disordered eating we find that the same problems abound, simply with a result in less extreme eating behaviors. Whoever suffers the “most psychological damage” could never truly be evaluated.

Why this matters to all of us

Problems with eating exist on a spectrum. On one far end of the spectrum are severe eating disorders. On the other end of the spectrum is a perfectly mentally happy and peaceful person.

But pretty much all of us exist somewhere in the range in between.

Even if someone does not technically “have a disorder,” she may be quite near disorders on the spectrum. And even if in some particular regard she manages to escape the “official disorder,” say, because she doesn’t meet the criteria of bingeing often enough, she still may be under a truly significant amount of emotional distress and need real help. This help could come from friends, or it could come from a therapist.

Unfortunately, today in our culture in order for an individual to get the most powerful treatment she must qualify as having a precise disorder. This is unfortunate, and I believe the DSM and psychological and psychiatric facilities need to work together in order to be more inclusive for their treatments for people who do not meet rigid criteria.

Fortunately, most psychologists I believe are attuned to the potential severity of mental pain regardless of whether someone meets the specific criteria, and so will be able to provide high quality help to the people who need it.

I wanted to raise these points today because I believe we need to have more sympathy for everybody: more sympathy for those with official disorders, more sympathy for those who don’t qualify as having disorders, and more sympathy for ourselves. This last point is particularly important for many of us: just because our problems aren’t “official” doesn’t mean they aren’t problems. It doesn’t mean they aren’t worth addressing. They are. They truly are.

And, as with all psychological problems, with both support from our therapists, our friends, our communities, and whoever we may find ourselves amongst, and with unending forgiveness and patience for ourselves, we really can overcome the problems. The first step is acknowledging that they are real, and that we are not alone.

What do you think? Questions, comments, concerns, communal love? Love my ideas, hate them? I live for your thoughts!

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16 Comments

Breana
on March 17, 2016 at 2:46 pm

You spoke to my heart Stef. I have suffered from disordered eating since I was about eight. From what I can remember. And even though it wasn’t severe, Life threatening or diagnosed I never got help for it and had to find freedom my own way. I remember being around food at a party or gathering and wondering how all the people around me weren’t eating all the food. How could they just be there and not want to eat IT ALL. I would come home from school or work and stand there and eat snack food until it was gone and there was nothing left. It was just a few years ago that I actually realized I had a problem. People do really need help and support. They need love. I loved this post.

Awesome. Me too. I always had the same thing. WHY ISN’T EVERYONE ELSE EATING ALL THE TIME, TOO. It’s much better, now, though I can very easily get sucked back into it. It’s only feeling so much love and after having done so much work that I am capable of feeling more free around food. So glad that you are walking the same path. <3

Yes! Thank you for writing this!
I feel like almost all people growing up in this culture are on that spectrum. Even if they feel fine around food they may be contributing to another person’s disordered eating by saying things like “Oh you always eat salads, you eat so healthy!” or ” You look good, have you lost weight?” which, by our cultural standards, it considered totally normal!

I have classic signs of binge eating disorder and didn’t know it was classified in the DSM. I’ve never thought about getting counseling for it but after reading this perhaps I should look into it. I wouldn’t really know where to start and would have to find a person who really understood it to feel comfortable I think.

It didn’t occur to me that I dealt with disordered eating until I started listening to the Paleo Women Podcast. The more I listened, the more I realized that the “prescribed” 1200-1400 calories per day that the nutritionist at my gym suggested I eat was way too low for the amount of exercise I do (interval workouts 5-6 days per week). I’m going on my 3rd week of eating closer to 1800 -2000 calories and I feel so much better. I feel alive again really. Even though I might carry a little extra weight (5’2″ 144lbs) I think I’m doing alright since my 40th birthday is in a few months and I can keep up with all those girls half my age in the interval classes that I take. Before the Paleo Women Podcast I didn’t think that way though. So thank you, Stefani and Noelle! 🙂

Brilliant Stefani. I’m so glad to see you talking about this. I battled with disordered eating from the time I was a kid too. My self-esteem was completely tied to the scale and the drive to figure out how to lose weight and be “thin and beautiful” actually drove me to seek knowledge and I become a holistic nutritionist, then a sports nutritionist, then a personal trainer and finally an Emotional Freedom Technique practitioner. All the nutrition and fitness knowledge in the world won’t help someone dealing with disordered eating..just the opposite in most cases. When I dealt with the emotional issues behind my disordered eating my life changed for the better. I love my body now, at 41 I’m healthier than I’ve ever been, physically and mentally, and it just keeps getting better. EFT is sometimes referred to as tapping and it’s an evidence-supported technique that a lot of therapists use to treat addictions, PTSD, anxiety etc and it’s been pivotal for me in ending (largely) my emotional battle with food and my body. I’d encourage anyone looking for answers to emotional/psychological issues to investigate it. You can learn it for free at the founders website..I won’t post it here because I’m not trying to sell anything, just wanted to share a powerful tool that’s helped me and thousands of other people as well. Thanks again for the attention to this REALLY important topic that is misunderstood by so many people!

Hi,
Thank you for your post. I have been starting to realize that my relationship with food has became difficult. I have a day when I eat freely without worrying about eating healthy but every week I feel like I eat more and more. I buy a lot of treats and on that day I eat until they are all gone no matter how stuffed I am. I also don’t do it in front of my husband because I am scared that he will judge me and I feel more comfortable eating by myself. Lately I have been doing this a little too often. I buy whatever I feel like eating at the moment and I eat until they are all gone. I finally decided to talk to my friends about it and she said that it looked like an eating disorder but after reading your post I think that I have a bad relationship with food. I do not know why I feel the need to eat so much at times but I know after dealing with things that have been stressing me out lately I did not feel the need to go buy a lot of food.
Thank you again for your post! I think it is important to have knowledge about it because often we think the way we eat is normal when it is really not.

so ironic you just did this blog! started listening to your podcast on a road trip home an ive been borderline addicted ever since. I have contemplated writing you about my eating disorder then saw this post! Just curious on your thoughts about someone trying to get over bulimia and the paleo approach. Do you think it would be too restrictive? Do you have any advice for someone trying to recover from bulimia? I have struggled wtih it for 11 year and for 5 years before that it was anorexia. I am now 29 and so tired….so tired of puking multiple times a day, of hating my body, of leading a double life. I cant afford treatment, and ive already been through two tx centers. Just curious on your thoughts. Im open to anything.

Yes, I think it might be too restrictive. it’s entirely possible to eat paleo and not be restrictive, but for someone with a history it is definitely harder. I think the most important steps to take are around body image, control, personal history issues, etc. Eating freely is a part of that. You may wish to pick up a book or two on therapies for eating disorders and read them yourself? Cognitive behavioral therapy has been shown to be quite effective.

Many never receive an official diagnosis, of course, because we do not seek help. I was a binge eater for years and then went through a time of severe restricting and obsessive exercising. But it was only this year that I read that my bingeing would have been classified as an eating disorder! I am a holistic nutritionist (a “chubby nutritionist”) and actually refuse to work with women on weight loss because of my past…although weight loss can sometimes occur as a by-product of the work we do. Not one of the women I have worked with so far haven’t wished their bodies were smaller. Not one. We expend so much time and energy on hating our bodies; it makes me so sad. I struggle here too- still, though conciously CHOOSE each day to speak and think and act with kindness toward my body.

I definitely have had disordered eating for a long time. I had undiagnosed food sensitivities starting at least in middle school – so I stopped eating until after school to avoid bathroom accidents. This got so extreme in college that I started throwing up after meals to avoid the pain and sudden diarrhea. A doctor said it was “IBS” and I should just get used to it. Eventually I started passing out a lot and I started eating more regularly – but I was terrified of food. Going gluten free helped, but didn’t fix things. I have other anxiety issues and often just stop eating more than once a day when I’m like that, but alternating with regular eating. The super fun thing is I’m pretty overweight and so most doctors won’t even believe me! They think I secretly binge every night in all the unhealthy foods. I feel like food is my enemy no matter what I do. It sucks.

I’ve only recently really realized how messed up my relationship to eating is.

Glad to hear you’re on the road to betterment, Emily. Sounds like you may need some serious attention to your gut health – have you looked into a GAPS diet, the SCD diet, or an autoimmune protocol? Those are probably the best starting places to get your gut feeling better – or, better yet, talking to a functional medicine practitioner who specializes in the gut <3

I suffer from disordered eating but have never been taken seriously because I’m not extremely underweight and people just say ‘Its sad you feel that way about your self because your really don’t look like you have an eating disorder.’ This has actually made me feel even more self contious about my weight because I feel like I don’t have the right to say I have an eating disorder. My friends mention that I don’t eat much but they don’t actually know that I have issues so they just joke about it but I can get panic attacks and I have self-harmed but I when people notice they think that I do it for attention or something but because I’m not dangerously skinny no one really seems to care so I guess that they are right, its a plea for attention. Thank you for this article it has helped me understand that i do have issues and I’m not faking it.

Yes, of course. <3 Please feel at home here, we recognize how hard it is to relate to food even though it "seems normal." If your'er struggling with self harm and the like I would recommend seeing a therapist about it, and still of course please count me and the others here as supportive friends <3